Personality Functioning Improvement during Psychotherapy Is Associated with an Enhanced Capacity for Affect Regulation in Dreams: A Preliminary Study.

BACKGROUND: Clinical case illustrations of patients with an impairment of personality functioning (IPF) have repeatedly reported that progress during psychotherapy is reflected by alterations in dream content. However, quantitative studies based on samples of psychotherapy patients are scarce. As a core component of both personality functioning and contemporary psychodynamic dream theory, the construct of affect regulation is of specific significance in this context. AIMS: To test if improvement in personality functioning in the course of psychotherapy is associated with an increasing ability to regulate affects in dreams. METHOD: In a longitudinal design, affect regulation was compared in N = 94 unsolicited dream reports from the first vs. last third of long term psychotherapy of ten patients with initial IPF. Dream reports were transcribed from recordings of the sessions. Expert ratings of the level of personality functioning were obtained using the Scales of Psychological Capacities. The capacity for affect regulation was assessed using the Zurich Dream Process Coding System. Group differences were assessed using linear mixed models, controlling for dream length as well as the nested structure of this data set. RESULTS: Patients demonstrated an increased capacity for affect regulation in dreams that was primarily evident in three core features: the complexity of dream elements (cf., e.g., parameter attributes, p = 0.024); the extent of affective involvement in the dream ego (cf., e.g., parameter subject feeling, p = 0.014); and the flexibility to regulate the dynamics of safety/involvement processes (p ≤ 0.001). This pattern was especially prominent in a subgroup (n = 7) of patients with more pronounced improvements in personality functioning. CONCLUSION: These findings support the hypotheses that decreasing IPF during psychotherapy is associated with increases in the capacity for affect regulation in dreams. Thus, researchers and therapists can utilize dream reports to illuminate the important aspects of treatment progress in clinical practice.

Being right vs. getting it right: orientation to being recorded in psychotherapeutic interaction as disaffiliative vs. affiliative practice.

Introduction: The study focuses on the orientation to being recorded in therapy sessions, emphasizing that these practices adapt to specific circumstances and influence subsequent actions. The study suggests a way to deal with the insolubility of the "observer paradox": to accept that observation has an impact on the observed, but that the recorder is not necessarily a negative determinant. Furthermore, the study builds on the idea that participants' orientations to the recorder can be seen as actions. Methods: The data included in this study were collected from four psychodynamic therapies. A total of 472 sessions were searched for orientation to be recorded. Twenty-three passages were found and transcribed according to GAT2. Of the 23 transcripts, six excerpts have been analyzed as part of this article. The analysis of this study was done through Conversation Analysis. Results: The study explores how participants use the orientation to be recorded to initiate or alter actions within conversations, which can help achieve therapeutic goals, but can also hinder the emergence of a shared attentional space as the potential to disrupt the therapist-patient relationship. The study identifies both affiliative and disaffiliative practices, noting that managing orientation to be recorded in a retrospective design consistently leads to disruptive effects. Moreover, it highlights the difference between seeking epistemic authority ("being right") and managing recording situations ("getting it right") in therapeutic interactions as a means of initiating patients' self-exploration. Discussion: The integration of recordings into therapeutic studies faces challenges, but it's important to acknowledge positive and negative effects. Participants' awareness of recording technologies prompts the need for a theory of observation in therapeutic interactions that allows therapists to visualize intuitive practices, incorporate active contributions, counteract interpretive filtering effects, facilitate expert exchange, ensure quality assurance, and enhance the comprehensibility of therapeutic processes. These aspects outline significant variables that provide a starting point for therapists using recordings in therapeutic interactions.

[Interpersonal patterns in obese patients]. / Interpersonelle Muster bei Adipositaspatienten.

In the last decades the number of obese and pre-obese patients in Western industrial nations increased. Obese patients have been largely unsuccessful in losing weight over time, but the causes of their difficulties and the causes of their obesity have remained unclear. We examined whether the attachment style and its interaction with interpersonal processes would shed light on this question. We analyzed 107 obese or pre-obese patients before the start of a weight loss intervention program. We used the Adult Attachement Prototype Rating (AAPR)-interview and related questionnaires (Helping Alliance Questionnaire (HAQ), Inventory of Interpersonal Problems (IIP-D), Brief Symptom Inventory (BSI)). According to the AAPR-rating 54% of the patients were secure and 46% insecure attached. The results suggest that insecure attachment style has an impact on psychic strain in obese patients unrelated to weight, gender and age. Additionally the insecure attachment style influences the therapeutic alliance experienced by patients and the therapist.

Attachment style contributes to the outcome of a multimodal lifestyle intervention.

BACKGROUND & AIMS: The long-term success of life-style interventions in the treatment of obesity is limited. Although psychological factors have been suggested to modify therapeutic effects, specifically the implications of attachment styles and the patient-therapist relationship have not been examined in detail yet. METHODS: This study included 44 obese patients who participated in a one-year multimodal weight-reduction program. Attachment style was analyzed by the Adult Attachment Prototype Rating (AAPR) inventory and its relation to a one-year weight reduction program was studied. The patient-therapist-relationship was assessed using the Helping Alliance Questionnaire. RESULTS: Attachment style was secure in 68% of participants and insecure (preoccupied and dismissing) in 32%. Interestingly a significantly higher weight-reduction was found in securely (SAI) compared to insecurely attached individuals (UAI; p < 0.05). This estimation correlated positively also to the quality of helping alliance (p = 0.004). CONCLUSIONS: The frequency of insecure attachment in obese individuals was comparable to that of the normal population. Our data suggest a greater weight-reduction for SAI than for UAI, and the patient-therapist relationship was rated more positively. The conclusion can be drawn that a patient's attachment style plays a role in an interdisciplinary treatment program for obesity and has an influence on the effort to lose weight.

Somatic comorbidity in anorexia nervosa: First results of a 21-year follow-up study on female inpatients.

BACKGROUND: Anorexia nervosa is a severe psychosomatic disease with somatic complications in the long-term course and a high mortality rate. Somatic comorbidities independent of anorexia nervosa have rarely been studied, but pose a challenge to clinical practitioners. We investigated somatic comorbidities in an inpatient cohort and compared somatically ill anorexic patients and patients without a somatic comorbidity. In order to evaluate the impact of somatic comorbidity for the long-term course of anorexia nervosa, we monitored survival in a long-term follow-up. METHOD: One hundred and sixty-nine female inpatients with anorexia nervosa were treated at the Charité University Medical Centre, Campus Benjamin Franklin, Berlin, between 1979 and 2011. We conducted retrospective analyses using patient's medical and psychological records. Information on survival and mortality were required through the local registration office and was available for one hundred patients. The mean follow-up interval for this subgroup was m = 20.9 years (sd = 4.7, min = 13.3, max = 31.6, range = 18.3). We conducted survival analysis using cox regression and included somatic comorbidity in a multivariate model. RESULTS: N = 41 patients (24.3%) showed a somatic comorbidity, n = 13 patients (7.7%) showed somatic comorbidities related to anorexia nervosa and n = 26 patients (15.4%) showed somatic comorbidities independent of anorexia nervosa, n = 2 patients showed somatic complications related to other psychiatric disorders. Patients with a somatic comorbidity were significantly older (m = 29.5, sd = 10.3 vs m = 25.0, sd = 8.7; p = .006), showed a later anorexia nervosa onset (m = 24.8, sd = 9.9 vs. m = 18.6, sd = 5.1; p < .000) and a longer duration of treatment in our clinic (m = 66.6, sd = 50.3 vs. m = 50.0, sd = 47; p = .05) than inpatients without somatic comorbidity. Out of 100 patients, 9 patients (9%) had died, on average at age of m = 37 years (sd = 9.5). Mortality was more common among inpatients with somatic comorbidity (n = 6, 66.7%) than among inpatients without a somatic disease (n = 3, 33.3%; p = .03). Somatic comorbidity was a significant coefficient in a multivariate survival model (B = 2.32, p = .04). CONCLUSION: Somatic comorbidity seems to be an important factor for anorexia nervosa outcome and should be included in multivariate analyses on the long-term course of anorexia nervosa as an independent variable. Further investigations are needed in order to understand in which way anorexia nervosa and a somatic disease can interact.

Psychodynamic mechanism and weight reduction in obesity group therapy - first observations with different attachment styles.

OBJECTIVES: Successful long-term results are extremely rare in non-surgical obesity treatment. Interactional difficulties with the attending physicians and the limited compliance of obese patients are a frequently described dilemma in repeated psychotherapeutic group treatment attempts. The type of relationship initiation and the attachment behavior probably play a central role in this connection but have not yet been systematically investigated. METHODS: This paper focuses on the attachment styles of obese subjects and their effects on psychodynamic group therapy within the context of a weight-reduction program. RESULTS: The attachment styles are characterized in 107 pre-obese and obese patients, and their effects on patients and therapists in group therapy are described. CONCLUSION: The paper surveys the motivational situation, clinical pictures, and repeated group topics.

The fatal outcome of an individual with anorexia nervosa and Sheehan's syndrome as a result of acute enterocolitis: a case report.

OBJECTIVES: To illustrate the close association between a disturbed psychosocial up-bringing, frequent physical illness, and medical interventions. METHOD: We report a case of a 44-year-old woman with anorexia nervosa (AN) and Sheehan's syndrome who died as a result of a toxic cardiac arrest. RESULTS: The patient presented with a BMI of 13.6 kg/m(2). She refused any intensive-care treatment and died from toxic cardiac arrest. Postmortem examination revealed an acute gastroenterocolitis. DISCUSSION: The history of this patient illustrates how psychological deprivation led to eating disturbances, early pregnancy, and the life-threatening delivery of twins. This resulted in a diagnosis of Sheehan's syndrome, hepatitis C, and a ventricular ulcer. A psychosocial event triggered a late exacerbation of her AN. A helpful alliance between patient and staff did not occur as she rejected it.

Advanced multifocal tuberculous spondylitis without disk involvement and with multidrug-resistant bacilli.

In this brief report, we describe a 23-year-old immunocompetent Nigerian patient with extensive multifocal tuberculous spondylitis without disk involvement. Cultures of sputum samples and biopsy samples from the L4 vertebra were positive for tuberculosis; drug-susceptibility testing of the isolates revealed multidrug resistance. Treatment with second-line drugs resulted in an excellent interim outcome after 6 months, without the need for surgical intervention.

[Did the Diagnostic Profile in Psychosomatically Examined Patients Seen by Consultation/Liaison-Services (CL Services) of Berlin Hospitals Change?]. / Hat sich das Diagnoseprofil bei psychosomatisch untersuchten Konsiliarpatienten an Berliner Krankenhäusern verändert?

The aim of this study was to find out whether the diagnostic profile for patients seen in the psychosomatic Consultation-Liaison (CL) services in three Berlin hospitals in 1994 and 2001changed. All referrals to the psychosomatic CL service within 3 months in 1994 (N = 229) and within 3 months in 2001 (N = 196) were recorded and documented. It could be shown that the referred patients of the three Berlin hospitals more frequently had only mentally caused symptoms (without organ diseases) in the first data recording (1994) and more frequently organic diseases with concomitant mental comorbidity in the second data recording (2001). If this finding reflects a general tendency, it requires an adjustment in the competence of psychosomatic CL services and health policies that ensure the inclusion of mental aspects in hospital care.

[Differences between female and male patients with eating disorders--results of a multicenter study on eating disorders (MZ-Ess)]. / Unterschiede zwischen weiblichen und männlichen Patienten mit einer Essstörung--Ergebnisse der multizentrischen Essstörungsstudie (MZ-Ess).

Publications about men with eating disorders are still rare. Therefore, in view of the current status of the findings, it seems worthwhile to examine the differences that are empirically verified as well as the relevant common features between the sexes. Based on a representative sample, therefore, male and female patients with eating disorders in inpatient treatment are compared in terms of demographic and clinical variables (symptoms and personality), both at the beginning of treatment and two-and-a-half years after the inpatient treatment, and the findings are discussed with regard to their "gender specificity". The study covered 1,171 patients (male and female) with the diagnosis criteria for anorexia, bulimia and double diagnosis according to DSM-III-R; 33 of them were men. Anorexia cases (342 women and 13 men) and bulimia cases (629 women and 18 men) were compared at the beginning of treatment with the following instruments: Symptom Checklist 90-R; Eating Disorder Inventory; questionnaire for the symptom diagnosis of eating disorders; Freiburger Persönlichkeitsinventar and Narzissmus-Inventar. As a measure of success in the 2.5 year catamnesis (764 women and 20 men), operationalized criteria were defined using the LIFE. The 2.8 % share of men with eating disorders in inpatient treatment again confirms the special nature of this clinical disorder for men. An interesting result is the later onset of illness in male anorexia cases. Coinciding with comparable studies, there are only minor differences in eating behavior, but the differences in body experience are much more pronounced. In bulimic men, there is a higher percentage of homosexuals and they are more satisfied with their body. Anorectic men have a greater gain from the illness, are more concerned about their health and are less performance-minded than female anorectics. The differences that were found clearly indicate that these occur especially in the area of dealing with the body and the significance of the body. One of the reasons why the results in the area of personality and sexual identity are interesting is that they point to differences which definitely appear to be significant, not just between the sexes, but also between male anorexia and bulimia.

[Importance of the therapeutic alliance experience for the differential psychotherapeutic indication]. / Die Bedeutung des Beziehungserlebens für die differenzielle Psychotherapieindikation.

The influence of the therapeutic alliance experience on the recommendation for psychotherapy and prognosis was examined in a retrospective study. Three hundred seventy-four of 3270 patients who presented at the psychosomatic-psychotherapeutic outpatient service at the Benjamin Franklin Hospital of the Free University of Berlin between July 1994 and December 1999 were selected based on the fact that they had been examined only by a psychoanalyst and recommended for individual psychoanalytical outpatient therapy, nondirective therapy (according to Rogers) or behavioral therapy. Results of the unifactorial variance analysis: The better the alliance is assessed, the sooner procedures for psychoanalytical therapy are recommended (F = 35.85; p < 0.000) and the better the assessment of the prognosis (r = 0.68; p < 0.000). The results confirm the importance of the therapeutic working relationship and correct the assumption that the indication and prognosis are exclusively diagnosis or patient-related, clearly showing that they are the result of an interactive process.